Subretinal Hyperreflective Material in the Comparison of Age-Related Macular Degeneration Treatments Trials

Abstract

Purpose: To evaluate the association of subretinal hyperreflective material (SHRM) with visual acuity (VA), geographic atrophy (GA), and scar in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).

Design: Prospective cohort study within a randomized clinical trial.

Participants: The 1185 CATT participants.

Methods: Masked readers graded scar and GA on fundus photography and fluorescein angiography and graded SHRM on time-domain and spectral-domain (SD) optical coherence tomography (OCT) throughout 104 weeks. Measurements of SHRM height and width in the fovea, within the center 1 mm(2), or outside the center 1mm(2) were obtained on SD OCT images at 56 (n = 76) and 104 (n = 66) weeks.

Main outcome measures: Presence of SHRM, as well as location and size, and associations with VA, scar, and GA.

Results: Among CATT participants, the percentage with SHRM at enrollment was 77%, decreasing to 68% at 4 weeks after treatment and to 54% at 104 weeks. At 104 weeks, scar was present more often in eyes with persistent SHRM than in eyes with SHRM that resolved (64% vs. 31%; P < 0.0001). Among eyes with detailed evaluation of SHRM at weeks 56 (n = 76) and 104 (n = 66), mean VA letter score was 73.5 (standard error [SE], 2.8), 73.1 (SE, 3.4), 65.3 (SE, 3.5), and 63.9 (SE, 3.7) when SHRM was absent, present outside the central 1 mm(2), present within the central 1 mm(2) but not the foveal center, or present at the foveal center (P = 0.02), respectively. When SHRM was present, the median maximum height under the fovea, within the central 1 mm(2) including the fovea and anywhere within the scan, was 86 μm, 120 μm, and 122 μm, respectively. Visual acuity was decreased with greater SHRM height and width (P < 0.05).

Conclusions: In eyes with neovascular age-related macular degeneration (AMD), SHRM is common and often persists after anti-vascular endothelial growth factor treatment. At 2 years, eyes with scar were more likely to have SHRM than other eyes. Greater SHRM dimensions were associated with worse VA. In eyes with neovascular AMD, SHRM is an important morphologic biomarker.

Conflict of interest statement

Conflict of Interests:

Alex Willoughby: None

Gui-Shuang Ying: Janssen (Consultant)

Maureen Maguire: Genentech: (Consultant)

Cynthia Toth: Alcon Laboratories (Patent); Bioptigen (Financial Support); Genentech (Financial Support); Physical Sciences Inc. (Financial Support)

Russell Burns: None

Ebenezer Daniel: None

Juan E. Grunwald: None

Glenn Jaffe: Heidelberg Engineering (Consultant); Alcon (Consultant); Neurotech (Consultant); Roche (Consultant)

Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

A Average foveal subretinal hyper-reflective material thickness (86u) that is distinguishable from the underlying retinal pigment epithelium layer B Subretinal hyper-reflective material (100u) that is indistinguishable from underlying retinal pigment epithelium layer

Figure 2

Subretinal hyper-reflective material measurements over geographic atrophy (yellow parallel lines border area of geographic atrophy)